31 Aug 2015

Reale L et al. Postgrad Med 2015; 127: 671-676.

Shortcomings in continuity of care for young people with ADHD transitioning to adult mental health services in Italy need to be addressed in order to avoid gaps in treatment, suggests a qualitative study.

Prompted by a lack of formal guidance for people with ADHD, despite governmental recognition of the need for close co-operation between child and adult mental health services in Italy, this study examined the transition of people with ADHD from child/adolescent to adult mental health services. Results of a literature review were used to develop a questionnaire (validated by experts) which was administered to parents of individuals with ADHD* (n=24) who had reached the transition boundary for adult mental health services (i.e. were aged ≥18 years), and child psychiatrists (n=27) of CANPS† within the Lombardy region.

At the time of the study, four individuals were undergoing treatment with a combination of pharmacotherapy and psychological therapy, three with pharmacotherapy only, and eight with psychoeducational interventions. A reduction in access to CANPS was reported over the course of the study, along with a slight increase in the use of adult mental health services. Of the 12 individuals under the care of either CANPS or psychiatrists within the public or private systems, none had been referred to the adult service by CANPS clinicians.

Gaps in care at the age of 18 represented a major challenge for parents of individuals with ADHD. Related difficulties included a lack of information regarding available adult services and problems accessing these services. The experiences of the clinicians broadly reflected those of the parents and included high rates of unaccepted referrals, poor communication and lack of shared protocols between child and adult services, as well as difficulty in finding appropriate adult services. Sharing of information, a time limit on the transition process of 2–6 months with parallel care running during this time and parental involvement in the transition were among key suggestions made by clinicians for optimising the transition process.

Having identified a lack of continuity of care for people with ADHD transitioning to adult mental health services in Italy, this study highlights the importance of gradual preparation, a period of parallel care and clear information regarding available services. The authors highlight the small sample size and the qualitative nature of the survey as potential limitations, and acknowledge that it is not possible to extrapolate these findings beyond the geographical region of the study.